Children's Oral Health

Infants

Parent to Child Decay Transmission

This may come as surprise to many parents, but one of the best things a parent can do to prevent dental decay in their child is to make sure their own teeth are free of decay. Studies have shown that with some children with severe decay, the type of bacteria causing it was identical to the bacteria in the mother's mouth.

Apparently, in casual contact (such as sharing an ice cream cone) the bacteria from a parent's saliva can be transferred to the child's mouth and can cause decay. When parents say that their child inherited their bad teeth, the truth may be that the child received the bacteria from the parent with decay. Parents may also want to make sure that their child’s daycare provider is not suffering from dental disease as well.

Pacifiers

There have been suggestions made that parents sucking on a pacifier before putting it in an infant’s mouth can help reduce development of allergies in the infant. However, as described above, this practice can also increase a child’s development of decay as a parent or caregiver’s oral bacteria, particularly strep mutans, is shared. This dental susceptibility from shared bacteria can be the beginning of long-term decay problems as a child grows. For the dental health of a child, it is recommended that no pacifiers, food, or eating utensils be shared, and mouth-to-mouth contact should be discouraged.

Pacifiers can also be an issue in proper development of teeth alignment if they are used beyond the early years, particularly if a child sucks vigorously on them. Minimizing pacifier use for infants to avoid the development of a strong habit, and eliminating use as the child gets older are both important considerations. A consult with the dentist about pacifier use is a good idea so that the child can be monitored for potential problems.

Thumbsucking

Children suck their thumbs as a natural, comforting reflex. However, as permanent teeth erupt, this practice can be deleterious to teeth alignment and development of the roof of the mouth. Problems are more likely to develop if sucking is vigorous. If a child does suck his or her thumb or fingers, we recommend a discussion with the dentist so that mouth development and tooth alignment can be monitored.

Fluoride

If a mother is breast feeding, or is using a non-fluoridated source of water for a baby (including both well water and bottled water), there is a need to obtain a prescription for fluoride drops from a pediatrician to strengthen the developing teeth. The dosage for fluoride changes at age one and again at age three, so it is important to keep up to date on the amount a child needs. Usually by age one the prescription changes from drops to a chewable tablet or measured liquid. It is very important to keep this medicine locked up, out of a child's reach. It is also possible to buy fluoridated bottled water, available in the infant food department at the grocery store.

Bottle Mouth Syndrome

This is one of the most serious problems faced by infants, yet it is entirely preventable. This condition results when an infant is allowed to take a bottle to bed. When milk or juice is used for the bedtime bottle, the sugar in the beverage pools around the baby teeth and allows decay to form. This decay can be so severe that the front teeth can be decayed off to the gum line, and can cause serious abscesses. Correcting this condition and restoring the baby teeth is complicated and expensive, and may require hospitalization and general anesthesia.

This condition can be prevented simply by never giving a baby a nighttime bottle containing anything other than water, and by cleaning the baby’s teeth after giving a bottle before bedtime. It is surprising how many people do not know about this danger to babies, so we ask patients to please pass the word to relatives or friends with infants about the serious consequences of giving a bedtime bottle of milk or juice.

Cleaning Baby’s Teeth

Babies’ teeth need to be cleaned as soon as they erupt. This is easily accomplished by wiping with a piece of gauze or a clean washcloth twice a day. Some baby stores sell special finger cots for this process, which may be helpful. Do not use any toothpaste before age two.

After age two, brushing a child's teeth with a toothbrush is appropriate, but to prevent over-fluoridation, parents should not use more than a pea-sized about of toothpaste. It is most effective for a caregiver to lean a child back in his or her lap for the best access for brushing, and try to make it a fun time. A child may try to brush by him or herself, but we suggest that not be considered anything other than play. Until age six, a child simply does not have the dexterity to properly brush teeth. Be sure to keep toothpaste and any other fluoride products (such as adult fluoride gels) out of reach since ingestion of a large amount of toothpaste can result in an overdose of fluoride.

Teething

Infants usually begin teething between four and seven months, with teeth eruption schedules varying widely. There are twenty primary teeth that develop by age three. Teething can be uncomfortable for babies, and caregivers can provide some relief with moist cool gauze rubbed on the area, or through the use of a cool teething ring. Using infant teething products that contain benzocaine (e.g. – Baby Orajel) is not recommended as this chemical has been associated with a serious condition affecting oxygen carrying ability of the blood.

Infant Nutrition for Oral Health

Parents should follow pediatrician's advice when it comes to what to feed infants and toddlers, but here are a few guidelines for parents that can help form good habits and help prevent decay. One of the biggest dangers for poor nutrition is the overuse of juice or sweet drinks. Parents often believe that fruit juices are important for nutrition, but more than one small serving a day of juice is unnecessary. Too much juice can fill the child up and can actually cause malnutrition if it causes milk intake to decrease. Juices are also very sweet and can cause decay rapidly. Our advice is to provide only whole fruit, or if juice is administered, to limit consumption to one small glass at breakfast time, and make sure that fruit juice is used. Children should not be receiving sweetened fruit beverages instead of juice, and there is no need to spend money on juice boxes. They are a bad habit that a child does not need to start. Once solid foods are a part of a baby's diet, it is important not to use cookies and crackers too often. Like fruit drinks, they can fill a child up and prevent him or her from eating the foods really needed, and can contribute to tooth decay.

Pre-School Children

First Dental Visit

We generally like to see children in the dental office before age three, earlier if there is any hint of a problem. If while brushing a toddler's teeth any unusual spots on the teeth are noted, or if parents know that a baby used a bottle at bedtime or realize that diet has not been optimal for a toddler, a child should be checked out even if he or she is younger than three.

Permanent Teeth Eruption

The first permanent teeth to erupt are the six-year-old molars, which come in behind the primary teeth molars at ages 5-7. Parents may be surprised by this since no baby teeth come out when this happens. After the molars erupt, the permanent dentition schedule includes the eruption four central and then the four lateral incisors between 6 – 8 years, then canines erupt at 9-10 years. First premolars erupt on average at ages 10-12 years, followed by second premolars at ages 11 -12. The second molars erupt around ages 11-13, and finally the third molars, or wisdom teeth, erupt at ages 17-21.

Cleaning Teeth

As an infant becomes a toddler, brushing a child's teeth with a toothbrush is appropriate, but to prevent over-fluoridation, parents or caregivers should not use more than a pea-sized about of toothpaste. Brushing twice a day is recommended, once in the morning and again at bedtime. It is most effective for a caregiver to lean a child back in his or her lap for the best access for brushing, and try to make it a fun time. A child may try to brush by him or herself, but we suggest that not be considered anything other than play. Until age six, a child usually does not have the dexterity to properly brush teeth. Be sure to keep toothpaste and any other fluoride products (such as adult fluoride gels) out of reach since ingestion of a large amount of toothpaste can result in an overdose of fluoride. Flossing should be added to a child’s routine when there are two teeth that touch each other. For further instructions, we advise that caregivers obtain personal advice from the hygienist at dental check-up visits.

Pre-School Diet

One habit that causes tooth decay problems is too much snacking, or use of food to keep a child quiet. Parents often use food to entertain a child, and it is not uncommon even in the dental office to see parents constantly shoving animal crackers, cookies, and cereal at the child to keep him or her occupied.

Snacking can be part of a child's diet, but it should be controlled, and should include more nutritious vegetables and fruits. We suggest that parents and caregivers make sure that snacking does not interfere with appetite for meals, and limit the number of times a snack is offered, because decay is more likely to happen when there are numerous exposures to sugars. (Even foods such as fruit or crackers still contain sugars.)

Since it can be difficult to keep a young child's teeth clean, it is especially important to keep sweet, sticky foods to a minimum. Some of the worst culprits are dried fruits, raisins, or fruit roll ups, or any hard candy that is sucked for a long time. Gummy candies or plain dark chocolate are less sticky and a better choice if candy is given as a treat. A good rule of thumb for how bad a food or beverage is for a child's teeth is to consider how sticky that food is if it gets ground into the kitchen floor.

School Age Children

Sealants

A child's first permanent teeth, the first molars (also known as the six year molars) erupt at around age six, and often parents don't realize their child has permanent teeth because they come in behind the baby teeth molars, and no baby teeth are lost before they come in. These molars tend to have deep grooves in the chewing surfaces and are very susceptible to decay. We generally advise having these teeth sealed to help prevent decay from forming in the grooves.

Dental X-Rays – Bitewings and Panorex

We generally take a set of bitewing x-rays around age six and then every two years after that to keep a check for cavities between a child's teeth. If a child has problems with decay, oral hygiene, or diet, we may consider him or her at high risk for between teeth cavities and take x-rays of problem areas at more frequent intervals until risk factors are lowered. We use extra-oral digital x-rays, which have the lowest radiation and are more comfortable as they do not require that sensors or films be placed between a child’s teeth.

We may take a panoramic x-ray (which shows the entire mouth and jaw area) around age six to assess a child's tooth development. This will let us know if there are any problems that will need to be addressed with orthodontics, and check for any abnormal development.

Orthodontics

As mentioned above, we will be assessing children for orthodontic needs at each visit. Some problems may require early intervention to correct, and others may wait until more permanent teeth have erupted. If there are any questions, we will advise a consult with an orthodontist.

If a child does begin orthodontic treatment, it is important to remember that braces make oral hygiene even more important since they can trap food particles and cause decay or gum problems. We recommend increasing dental cleaning visits to three-four month intervals while the child is bracketed to help prevent these problems.

Contact Sports and Mouth Protection

It is important to provide mouth protection for children playing contact sports. We see too many young injured athletes with chipped or knocked out teeth, and these problems can be prevented with a custom mouth guard. We can fabricate them at the office, or alternatively they can be purchased at a sports store.

Cavities Between Teeth

Many times younger children will not show decay, but as they approach teen-age years develop serious problems. This can usually be traced to a habit of sweetened beverages, particularly sodas or sports drinks. We recommend that parents do not buy sodas or sweetened drinks for use at home. Many teenagers will drink flavored bottled water instead. (Read the label to make sure there are no sweeteners added.) Ideally, beverages readily available at home should be limited to skim milk and water (with fruit juice allowed in limited amounts), with sodas or lemonade reserved for picnics and parties.

It should also be noted that failing to floss daily also contributes to between teeth decay since the plaque is not removed if the teeth are not flossed. (Brushing teeth provides very little effect for the spaces between teeth.)

Nutrition Concerns and Snacking

The same rules that apply to preschoolers - limiting snacking, sticky treats, and sugary beverages - also apply to school-age children.

It should be noted in addition how important it is for pre-teens to obtain enough calcium. It used to be believed that calcium for developing bones was important in the teen-age years, but recent research has found that this buildup of calcium is important in younger children as well. Children around age ten to twelve should receive four servings of low-fat dairy foods or other high calcium foods each day to help them keep healthy bones throughout life. Attention to diet at this age can help prevent osteoporosis later in life by promoting healthier bone throughout life, and could be a factor in resistance to periodontal disease as an adult.

Fluoride Treatment

It is easy to become confused with how different forms of fluoride work on a child's teeth, since we may be recommending fluoride tablets or gels at home and fluoride treatments in the office. Below is a description of how each type of fluoride works.

Fluoride tablets, like fluoride drops or liquids prescribed for infants, are swallowed and are utilized by the body to strengthen teeth that are still developing. Tablets do not do anything for teeth that have already erupted, although fluoride taken systemically is present in saliva, which may have some effect on erupted teeth.

Fluoride liquids prescribed at this office, if swished around in the mouth before swallowing, can strengthen both erupted teeth and developing teeth. Over the counter fluoride rinses may help erupted teeth, but are not meant to be swallowed and do not affect developing teeth.

The fluoride treatment delivered at the dental office is a strong fluoride gel that helps strengthen teeth that have erupted by delivering fluoride into the tooth structure. Children's teeth continue to strengthen for a few years after eruption, so fluoride is effective on them. Fluoride also strengthens areas of teeth that have weakened through the bacterial process that causes decay (decalcified) but have not yet actually decayed. Fluoride gels prescribed for home use are weaker versions of the fluoride used at the office.

Teens

Wisdom Teeth

One dental problem that occurs frequently involves the improper development of wisdom teeth, particularly impacted wisdom teeth. We generally take a panoramic x ray around age fifteen or sixteen to evaluate wisdom teeth development, and monitor any problems closely.

We do advise parents that if there are problems that cause us to advise extraction of the wisdom teeth, that this procedure be scheduled before a teenager goes away to college. It is much easier to extract a wisdom tooth in a young adult, and doing so can prevent serious problems later on. Every year we get calls from frantic parents asking what to do when their college student develops a serious infection from impacted wisdom teeth.

Teen Nutrition Concerns

Watching the way teenagers attack food, it is hard for parents to believe they were once picky eaters. Even though they generally eat plenty of food, it is important to stock the house with nutritious yet good tasting food. Teenagers are going to get plenty of junk food on their own, so making sure good choices are available at home helps them balance out their diet.

There are many simple food choices that can help teenagers obtain a balanced diet. Try to find whole grain cereals that are acceptable to them both for breakfast and as snacks, and use 100% whole grain bread. Having a fruit basket on the kitchen counter with plenty of citrus fruit makes it easy to get vitamin C, and regularly putting out a plate of raw vegetables in the evening helps with many vitamins and minerals. (Some of the easiest choices include carrots, sliced peppers, and celery sticks.) Soups with tomatoes or other vegetables can be nutritious option. Frozen prepared snacks such as burritos or pizzas can be nutritious, but it is still important for parents to check nutrition labels to evaluate for fat content, calories, sodium content, and to determine if whole grains, beans, or vegetables are included in the ingredient list.

The trick is to provide enough of a variety of good foods to satisfy their appetites so that there isn't such a craving for junk. Remember that the grocery store is where nutrition decisions are made - if high sugar or high fat foods aren't brought into the house in the first place, there isn’t the worry about the kids getting in to it at home. And of course, if junk food isn't available for the kids, it isn't there to tempt the adults in the household either.

Eating Disorders

Bulimia involving vomiting can cause serious dental problems of erosion to the teeth. We check for signs of this disorder at the dental office, and parents may want to be alert to this at home. While we can restore the teeth harmed by the disorder, any case should be handled with medical and psychological care to get at the root of the problem.

Piercings

Tongue or lip piercings can cause infections and must be carefully watched. Unlike ear piercings the lip and tongue piercings penetrate highly vascular connective tissues that are prone to deep infections. Trauma to teeth is also a frequent occurrence if the patient habitually taps the stud against the teeth. We advise against this practice, but if a teenager is going to have oral piercings, we advise them to watch carefully for signs of infection and come to the dental office immediately if any problems are noticed.

Juvenile Periodontal Disease

While periodontal, or gum, disease is usually considered an adult problem, it can develop in teenagers and if it does it can be very serious. This usually happens when there is a family history of the disease, although both stress and smoking by a teenager can aggravate a periodontal condition.

To help prevent this condition from developing, we recommend that teenagers have floss readily accessible even at school, and advise parents to set a good example by flossing themselves. We also advise parents to make sure that teenagers do not slip by with less frequent dental visits, because the juvenile type of periodontal disease can cause destruction rapidly. If a child develops red, bleeding, puffy gums, a dental appointment should be made right away for evaluation.